RENO, Nev. — Doctors hear alarms go off so often inside emergency rooms that they barely bat an eye. For many, controlled chaos is the environment they know.
But when a coworker is wheeled in on a stretcher, that alarm becomes a wake-up call.
Tragically, that wake-up call happens often in the U.S., according to the American Psychiatry Association (AP). The APA estimates 300 to 400 doctors die by suicide each year — a rate of 28 to 40 per 100,000 or more than double that of the general population. All told, it’s the highest suicide rate among any profession, per the APA.
These statistics come before physicians saw the global coronavirus outbreak overwhelm hospitals across the country, a pandemic that has resulted in 7.95 million cases and 217,000 deaths and counting since March.
“Most people don’t even know that that’s an issue,” said Colleen Camenisch, executive director of the Nevada Physician Wellness Coalition (NPWC), a Reno-based nonprofit working to provide support to physicians and their families through information, education and a resource line. “I think COVID has highlighted the issues with healthcare organizations and healthcare workers that there’s a high rate of burnout. And that’s been true long before COVID for physicians.”
Beckers Hospital Review in June released a survey showing that 44% of physicians reported high levels of “burnout” — physical and emotional exhaustion that can lead to insomnia, lack of appetite and other mental health issues. What’s more, 63% said they had “severe” or “near severe” stress levels in the last four weeks.
“One of the big contributors to physician burnout and suicide is the culture of silence,” said Camenisch, noting the NPWC is striving to destigmatize the concept of doctors seeking mental health services. “They don’t talk about it among each other or really any of the things that they see. They see more life and death and difficult diagnosis than we will in our lifetime, and yet they don’t share that experience with each other very often in meaningful ways.”
Camenisch said physician burnout might also negatively impact the quality of care doctors are trying to deliver day after day amid the pandemic.
“Errors tend to increase, and doctors have a harder time connecting with patients in the same way when they’re burnt out,” she said.
For Nevada, where demand for physicians continues to exceed supply, the burnout factor is an especially troubling reality.
The state ranks 48th for board-certified physicians per 100,000 people, according a 2017 report by the Health Resources and Services Administration (HRSA).
This is despite Nevada being one of the fastest-growing states by population in the country — increasing from about 2.7 million in the 2010 census to an estimated 3 million in 2018.
In Northern Nevada, Washoe County has seen a total of COVID-19 10,984 cases and 180 deaths as of Oct. 14, according to the county health district’s regional response team.
“Here we already have a shortage, so COVID put an extra burden on the people that are serving our population,” Camenisch said.
A shortage of physicians and increasing rates of burnout has an economic impact on the state, as well.
Camenisch cited data from the 2018 American Medical Association Economic Impact Study, which showed Nevada has a total of 5,056 physicians, a group of doctors that support 61,063 jobs. The economic activity generated by physicians in the state is $10.9 billion.
In all, doctors make up 7.7% of the gross state product, generating $387.9 million in tax revenue.
“One of the impacts of physician burnout that I think a lot of people don’t think about is that a lot of physicians decide to retire early,” Camenisch said. “For us, we already have a huge shortage of physicians, and a lot of people that are physicians are not recommending the career path for people that could consider that as a career.”
To that end, Camenisch pointed out that many big companies considering moving to Northern Nevada factor in the quality of — and access to — healthcare that the region can provide.
“It’s significant for our community to pay attention to,” she said. “It’s not just a health problem — it’s a business problem, it’s an economic problem.”
Needless to say, physicians are not the only group of people experiencing mental health issues in Northern Nevada and beyond as a result of the COVID-19 crisis.
From job losses to working-from-home stresses to fear and anxiety about the virus, the pandemic (and subsequent economic downturn) has negatively affected many people’s mental health, said Jolene Dalluhn, executive director of Quest Counseling & Consulting, a provider of outpatient therapy and counseling in the Reno area.
“What that’s meant for us as a behavioral health agency is people were seeking counseling that otherwise have never sought counseling in their life,” Dalluhn said. “We’re seeing those clients who are reaching out for the first time ever saying, ‘I’m feeling very disconnected, I’m feeling some grief, some loss for how life used to be. Or maybe they’re not working and they have the loss of a job.”
As a result, Quest’s client volume has doubled during the pandemic. The agency went from seeing 240 clients back in January to 480 clients as of mid-October, Dalluhn said.
All the while, Quest increased its number of therapists on staff from 18 to 20. She added that 50% of the agency’s clients are being seen via telehealth.
A portion of clients, Dalluhn said, are parents trying to adapt to working from home while raising kids and having to play at-home teacher on digital school days.
“I think it’s really difficult, and just the demands on everybody can be overwhelming and exhausting,” she explained. “I think depression is setting in for a lot of people that maybe don’t have the energy to handle all of that. There’s a lot of insomnia. There’s maybe not as much self-care. And there are less outlets for people than we used to have.
“When you don’t have an outlet for what you need in your life, it can create mental health problems.”
Reno Behavioral Healthcare Hospital — a provider of inpatient and outpatient programs for psychiatric and addiction treatment — has also seen an increase of people develop depression for the first time, said Alexa Waldmann, director of clinical services.
From June through August, the hospital saw a 12% increase in patients compared to last year, according to Don Butterfield, director of business development.
“I really noticed an increase in anxiety and depression,” Waldmann said. “There’s that unknown fear. If you already have a tendency to be anxious, which we all do on some level, that really increases. And social distancing has caused people to isolate more; if you’re depressed and isolating, that’s not very helpful.”
As a side effect, more and more people are struggling with substance abuse and seeking help, said Dalluhn, noting Quest’s self-referrals are up 9% compared to last year.
“People are reaching out saying, ‘I’m drinking more, I’m using more drugs, I’m alone a lot,” she said.
Added Waldmann: “People are staying at home with increased anxiety, not sure how to manage things, and then they fall back on their old coping skills.”
While agencies work to help people navigate their mental health issues, it’s easy to forget that behavioral healthcare workers — just like physicians — have their own struggles and stresses as a result of the pandemic.
“What’s occurring in the community is parallel to what our counselors are going through,” she said. “Our staff has to navigate and make adjustments and adapt to a lot of changes. As they go through that process, they’re helping our clients go through it. As a therapist and as a counselor, you’re trying to help people get through the same thing that’s difficult for you.”
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